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Pre-payment audits resumed Oct. 15

After a brief pause, PacificSource has resumed auditing pre-payment hospital claims, beginning October 15, 2021.  The policy document is available upon request and your Provider Service Representative is available to answer your questions.

Philips CPAP/BiPAP recall information

On June 14, 2021, Philips issued a recall notification for specific affected ventilation and sleep apnea devices. The notification informs patients, users, and customers of potential impacts on patient health and clinical use related to this issue.  If you represent a U.S. durable medical...

The time to recommend flu shots is now

With our region’s facilities currently overtaxed by COVID-19 patients, a major flu outbreak this fall would be especially dangerous. Current guidance from the CDC states that “everyone 6 months and older should get a flu vaccine every season with rare exceptions.” What can you do to help? Simple...

November 2021 Drug list Change Notification

Updates on Existing Criteria:  November 2021. The following changes to criteria are effective November 22, 2021: Prior Authorization Criteria – Clinical Updates Alemtuzumab – update required medical information and prescriber restrictions ...

October 2021 Drug list Change Notification

Updates on Existing Criteria: October 2021. The following changes to criteria are effective October 22, 2021: Prior Authorization Criteria – Clinical Updates Addyi & Vyleesi – Update exclusion criteria Benralizumab - add Pulmonologist as allowed...

September 2021 Drug list Change Notification

Updates on Existing Criteria: September 2021. The following changes to criteria are effective September 22, 2021: Prior Authorization Criteria – Clinical Updates Botox – Update exclusion criteria Krystexxa – For chronic gout, clarified required trial...

August 2021 Drug List Change Notification

Updates on Existing Criteria August 2021. The following changes to criteria are effective August 22, 2021:
Prior Authorization Criteria – Clinical Updates Antidiabetic Step Therapy – Add exception bullet for Farxiga new indication of chronic kidney...